Healthcare Provider Details

I. General information

NPI: 1992385579
Provider Name (Legal Business Name): ADRIAN EVERETT GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 KURTZ ST STE 150
SAN DIEGO CA
92110-4430
US

IV. Provider business mailing address

1660 HOTEL CIR N STE 314
SAN DIEGO CA
92108-2803
US

V. Phone/Fax

Practice location:
  • Phone: 619-214-2525
  • Fax:
Mailing address:
  • Phone: 619-961-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-CVFUBT
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: